Diabetes is a serious problem for American Indians, who suffer from some of the highest rates of diabetes in the world. Our preliminary work suggests that diabetes education is the strongest predictor of completion of recommended examinations, laboratory tests, and immunizations in the care of patients with diabetes. The Indian Health Service (IHS) has developed criteria to classify diabetes education programs into differing levels based on the extent of the organization and delivery of these services. There have been no published studies comparing the quality of diabetes care in Indian health facilities with differing levels of diabetes education programs. The purpose of this study is to determine whether there are significant differences in the quality of diabetes care among Indian health programs with differing levels of diabetes education programs. Our hypothesis is that patients who receive care in Indian health facilities with more comprehensive diabetes education programs will have higher rates of completion on indicators on diabetes care, and that facilities that become more comprehensive over time will also demonstrate higher levels of care. The study will address the following specific aims: 1. Determine if there are significant differences among Indian health facilities with differing levels of diabetes education programs in their performance on selected process and outcome indicators care using the IHC Diabetes Audit. 2. Determine which diabetes education program and facility characteristics are associated with better performance on indicators of diabetes care. This study will help determine if there are differences in the quality of care that patients receive in Indian health facilities with differing levels of diabetes education programs and services. The results of this study could be a first step in providing data on whether the IHS criteria and develop diabetes education programs are evidence-based, and on what program and facility characteristics are associated with improved quality diabetes care in the Indian health system.